Provider Demographics
NPI:1568754794
Name:ADU, COLLIN T (DPTGCSFAAOMPT MBA)
Entity Type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:T
Last Name:ADU
Suffix:
Gender:M
Credentials:DPTGCSFAAOMPT MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 MCKENDREE CHURCH RD STE 40
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4100
Mailing Address - Country:US
Mailing Address - Phone:678-257-4037
Mailing Address - Fax:678-819-7536
Practice Address - Street 1:1670 MCKENDREE CHURCH RD STE 40
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4100
Practice Address - Country:US
Practice Address - Phone:678-257-4037
Practice Address - Fax:678-819-7536
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009750225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist